Utero-cutaneous fistula after caesarean section delivery: diagnosis and management of a rare complication

Abstract

Utero-cutaneous fistula is an extremely rare condition characterized by an abnormal communication between the anterior wall of the uterus and the abdominal wall. The causes include multiple caesarean sections, incomplete hysterorrhaphy, miscarriages, uterine cavity revision, retention of placental material after delivery, use of drains, post-operative infections, or injuries. Herein, we report a case of a 38-year-old female, who underwent caesarean section 42 days earlier and presented to the emergency room complaining of fever, abdominal pain, and purulent discharge from the abdominal wall from 6 days. Her medical history included 2 previous term caesarean section deliveries and an hysteroscopic polypectomy 2 years earlier. A pelvic computed tomography scan with contrast medium showed fluid/super-fluid phlogistic collection reported at the anterior wall of the uterus with a continuous solution of the uterine wall itself. Magnetic resonance imaging demonstrated the presence of a probable hyperintense fistula, extended for 30 mm and 16 mm of thickness, which ended in the subcutaneous area with an abscess joint without continuous solution with the skin. A laparotomic surgical procedure was successfully performed. Histopathology confirmed the surgical suspect of utero-cutaneous fistula. Although utero-cutaneous fistula is an extremely rare complication, it should be considered if after caesarean section delivery signs and symptoms of skin inflammation and/or infection persist.

Keywords: caesarean section; hysterorrhaphy; postpartum complications; utero-cutaneous fistula.

Fig. 1

Pre-surgery magnetic resonance imaging shows (A) uterocutaneous fistula (arrows) in the sagittal plane and (B) in the axial plane

Fig. 2

Post-surgery magnetic resonance imaging shows absence of sinus pathways between (A) the anterior uterine wall and the abdominal wall, both in the sagittal plane and (B) in the axial plane